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NOTE: PULL ALL PERWTS (SEPTIC, WELL, ETC...) NItiKE COPIES FOR FILEXB <br /> LAND USE REPORT APP# fa -03 -- �S11 <br /> Rff ) <br /> EHD RECEIVED APP.REFERRAL:--L➢ J� COMPLETE & SUBMIT BY L-lzI zI j <br /> DA ) /DA <br /> T /,n 6 <br /> SITE ADDRESS: a I I <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e.: sewage disposal, <br /> water supplies, etc...). Where necessary, on an attached piece of plain paper, draw completed map of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> !/r'1.fT/(i--Illyt 1)rU- /-�9 (�ic✓�f5/�L..rrL✓7 ✓/ �,j.,.c '/ L�iLd�"' ��/ <br /> I recommend: Approval Continuance Inspector's Signature 1, ✓�' , <br /> Supervisor/Lead Senior Comments: <br /> i <br /> I <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 11 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />